18 LEADING MEDICINE: ADVANCED ORGAN FAILURE MANAGEMENT AND TRANSPLANT
Kirk Heyne, MD, and Howard P. Monsour, Jr., MD
WHERE ONCOLOGY MEETS TRANSPLANT: SUCCESS FOR PATIENTS WITH LIVER CANCER In collaboration with oncologists from The University of Texas MD Anderson Cancer Center, physicans at Houston Methodist are challenging current medical theory and proving it is possible to successfully transplant livers in patients with large liver cancers. Historically, it has been thought that large hepatocellular carcinomas and intrahepatic cholangiocarcinomas represent a poor indication for transplant due to a narrow disease-free window and low overall survival rates in those who do not undergo surgery. However, the team at Sherrie and Alan Conover Center for Liver Disease & Transplantation at Houston Methodist J.C. Walter Jr. Transplat Center continues to observe excellent outcomes in patients with both cancers — patients who were deemed to be outside the standard criteria elsewhere. A group of physicians from Houston Methodist — R. Mark Ghobrial, MD, PhD, director of the Conover Center; Howard P. Monsour, Jr., MD, chief of hepatology; and Kirk Heyne, MD, oncologist — have developed a strong collaboration with MD Anderson
oncologists Ahmed Kaseb, MD, and Milind Javle, MD, which allows for successful liver transplants in patients with these advanced primary liver cancers. At the 20th Congress of the International Liver Transplantation Society held in June 2014 in London, results were presented that demonstrated equal four-year survival in patients with large, out-of-criteria cancers when compared to patients with smaller, in-criteria hepatocellular carcinomas. The team has performed five successful transplants in these patients to date. “We’re transplanting cholangiocarcinoma patients who have responded to chemotherapy and remained stable and well on treatment after six months,” Monsour said. The partnership with MD Anderson has helped expand and accelerate the liver transplant program at Houston Methodist. “We’re looking at how we can transplant larger tumors,” Monsour said. “We’re working together with MD Anderson to do research and molecular profiling on the tumors. It has been an excellent collaborative program where both centers have benefited.”